Proposed Collection; Comment Request
[02/24/2005]
Volume 70, Number 36, Page 9109-9110
-----------------------------------------------------------------------
DEPARTMENT OF LABOR
Employment Standards Administration
Proposed Collection; Comment Request
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: The Department of Labor, as part of its continuing effort to
reduce paperwork and respondent burden, conducts a preclearance
consultation program to provide the general public and Federal agencies
with an opportunity to comment on proposed and/or continuing
collections of information in accordance with the Paperwork Reduction
Act of 1995 (PRA95) [44 U.S.C. 3506(c)(2)(A)]. This program helps to
ensure that requested data can be provided in the desired format,
reporting burden (time and financial resources) is minimized,
collection instruments are clearly understood, and the impact of
collection requirements on respondents can be properly assessed.
Currently, the Employment Standards Administration is soliciting
comments concerning the proposed collection: FECA Medical Report Forms,
Claim for Compensation (CA-7, CA-16, CA-17, CA-20, CA-1090, CA-1303,
CA-1305, CA-1331, CA-1087, CA-1332, QCM Letters, OWCP-5a, OWCP-5b, and
OWCP-5c). A copy of the proposed information collection request can be
obtained by contacting the office listed below in the ADDRESSES section
of this Notice.
DATES: Written comments must be submitted to the office listed in the
ADDRESSES section below on or before April 25, 2005.
ADDRESSES: Ms. Hazel M. Bell, U.S. Department of Labor, 200
Constitution Ave., NW., Room S-3201, Washington, DC 20210, telephone
(202) 693-0418, fax (202) 693-1451, E-mail bell.hazel@dol.gov. Please
use only one method of transmission for comments (mail, fax, or E-
mail).
SUPPLEMENTARY INFORMATION: FECA Medical Report Forms (CA-16, CA-17, CA-
20, CA-1090, CA-1303, CA-1305, CAT-1331, CA-1087, CA-1332, QCM Letters,
OWCP-5a, OWCP-5b, and OWCP-5c) and Claim for Compensation (CA-7).
I. Background
The Office of Workers' Compensation Programs (OWCP) administers the
Federal Employees' Compensation Act (FECA), 5 U.S.C. 8101 et seq. The
statute provides for the payment of benefits for wage loss and/or for
permanent impairment to a scheduled member, arising out of a work
related injury or disease. The Act outlines the elements of pay which
are to be included in an individual's pay rate, and sets forth various
other criteria for determining eligibility to and the amount of
benefits, including augmentation of basic compensation for individuals
with qualifying dependents; a requirement to report any earnings during
a period that compensation is claimed; a prohibition against concurrent
receipt of FECA benefits and benefits from OPM or certain VA benefits;
a mandate that money collected from a liable third party found
responsible for the injury for which compensation has been paid be
applied to benefits paid or payable. Before compensation may be paid,
the case file must contain medical evidence showing that the claimant's
disability is casually related to the claimants' federal employment. As
a particular claim ages, there is a continuing need for updated
information to support continuing benefits. The FECA Medical Report
[[Page 9110]]
Forms collect medical information from physicians which are necessary
to determine entitlement to benefits under the Act. The CA-7, Claim for
Compensation, requests information from the injured worker regarding
pay rate, dependents, earnings, dual benefits, and third-party
information. This information collection is currently approved for use
through August 31, 2005.
II. Review Focus
The Department of Labor is particularly interested in comments
which:
* Evaluate whether the proposed collection of information is
necessary for the proper performance of the functions of the agency,
including whether the information will have practical utility;
* Evaluate the accuracy of the agency's estimate of the burden of
the proposed collection of information, including the validity of the
methodology and assumptions used;
* Enhance the quality, utility and clarity of the information to be
collected; and
* Minimize the burden of the collection of information on those who
are to respond, including through the use of appropriate automated,
electronic, mechanical, or other technological collection techniques or
other forms of information technology, e.g., permitting electronic
submissions of responses.
III. Current Actions
The Department of Labor seeks the approval of the extension of this
information collection in order carry out its statutory responsibility
to compensate injured employees under the provisions of the Act.
Type of Review: Extension.
Agency: Employment Standards Administration.
Titles: Claim for Compensation, FECA Medical Reports.
OMB Number: 1215-0103.
Agency Numbers: FECA Medical Report Forms (CA-16, CA-17, CA-20, CA-
1090, CA-1303, CA-1305, CA-1331, CA-1087, CA-1332, QCM Letters, OWCP-
5a, OWCP-5b, and OWCP-5c) and Claim for Compensation (CA-7).
Affected Public: Individuals or households; Business or other for-
profit; Federal Government.
Total Respondents: 302,485.
Total Annual Responses: 302,485.
Estimated Total Burden Hours: 30,748.
----------------------------------------------------------------------------------------------------------------
Average
Forms Number of minutes per Burden hours
respondents response
----------------------------------------------------------------------------------------------------------------
CA-7............................................................ 400 13 87
CA-16........................................................... 130,000 5 10,833
CA-17........................................................... 60,000 5 5,000
CA-20........................................................... 80,000 5 6,667
CA-1090......................................................... 325 10 54
CA-1303......................................................... 3,000 20 1,000
CA-1305......................................................... 10 20 3
CA-1331......................................................... 250 5 21
CA-1332......................................................... 500 30 250
QCM Letters..................................................... 1,000 5 83
OWCP-5a......................................................... 7,000 15 1,750
OWCP-5b......................................................... 5,000 15 1,250
OWCP-5c......................................................... 15,000 15 3,750
-----------------
Total....................................................... 302,485 163 30,748
----------------------------------------------------------------------------------------------------------------
Frequency: As needed.
Total Burden Cost (capital/startup): $0.
Total Burden Cost (operating/maintenance): $120,994.00.
Comments submitted in response to this notice will be summarized
and/or included in the request for Office of Management and Budget
approval of the information collection request; they will also become a
matter of public record.
Dated: February 17, 2005.
Sue Blumenthal,
Acting Chief, Branch of Management Review and Internal Control,
Division of Financial Management, Office of Management, Administration
and Planning, Employment Standards Administration.
[FR Doc. 05-3491 Filed 2-23-05; 8:45 am
|
